Misunderstanding poor adherence to COVID-19 vaccination in Africa
Authors: Bernard Seytre
Journal: The Lancet Global Health (2022)

Although I can only applaud the call to action in favour of COVID-19 vaccination in Africa by Polydor Ngoy Mutombo and colleagues (March, 2022),1Mutombo PN Fallah MP Munodawafa D et al.COVID-19 vaccine hesitancy in Africa: a call to action.Lancet Glob Health. 2022; 10: e320-e321Summary Full Text Full Text PDF PubMed Scopus (9) Google Scholar their analysis of so-called COVID-19 vaccine hesitancy is questionable. Their first assessment that vaccine hesitancy in low-income and middle-income countries is caused by a dearth of knowledge about the fact that vaccines are the most effective public health interventions is contradicted by the evidence: 80% of infants in the WHO African region received a first diphtheria-tetanus-pertussis vaccine dose in 2019. The reference supporting their second argument on the historical, structural, and other systemic dynamics is a study done in the USA. Their third assertion that no firm commitment from the global community to expedite vaccine deployment to the African continent perpetuates vaccine hesitancy is based on two references that do not address this specific topic and don't include any African country. I and colleagues have done a quantitative socioanthropological study in five west African countries that revealed what appear to be the main drivers of the absence of adherence to COVID-19 preventive measures. For example, although very few people in our study wore a mask, 73·8–98·0% thought that a mask is useful to protect against COVID-19.2Seytre B Barros C Bona P et al.Revisiting COVID-19 communication in western Africa: a health literacy-based approach to health communication.Am J Trop Med Hyg. 2021; 105: 708-712Crossref PubMed Scopus (2) Google Scholar Only 3·2–39·7% of the interviewees knew that asymptomatic people can transmit the coronavirus and the qualitative part of our study revealed that many people believe COVID-19 is not present in their country.3Seytre B Barros C Bona P et al.Une enquête socio-anthropologique à l'appui de la communication sur le Covid-19 en Afrique de l'Ouest.MTSI. 2021; 1: 3Google Scholar These results confirm previous studies that showed that adherence to COVID-19 preventive measures is linked to risk perception.4Sarah D Schneider CR Kerr J et al.Risk perceptions of COVID-19 around the world.J Risk Res. 2020; 23: 994-1006Crossref Scopus (697) Google Scholar Therefore, besides the delivery of vaccines, the point is not to call for efforts to monitor and combat fake news, but to communicate the fact that COVID-19 is present in Africa, how the virus is transmitted, and who is at risk of the disease.5Seytre B Public perceptions, more than misinformation, explain poor adherence to proven COVID-19 control measures.Am J Trop Med Hyg. 2022; (published online Feb 9.)DOI:10.4269/ajtmh.21-1251Crossref PubMed Scopus (1) Google Scholar I declare no competing interests. COVID-19 vaccine hesitancy in Africa: a call to actionIn addition to low COVID-19 vaccine coverage in Africa due to vaccine nationalism and vaccine diplomacy, the gradual effort to distribute COVID-19 vaccines to low-income and middle-income countries (LMICs) is threatened by vaccine hesitancy. In Africa in particular, the low vaccine coverage1 and the ubiquitous vaccine hesitancy in a concerning proportion of the population undermine efforts to fight the COVID-19 pandemic. We advocate for humane, culturally relevant, and rapid public health action to address these issues. Full-Text PDF Open AccessMisunderstanding poor adherence to COVID-19 vaccination in Africa – Authors' replyWe welcome Bernard Seytre's engagement with our Comment.1 However, his response leaves us more perplexed than enlightened. It is not clear whether Seytre is questioning the sources or disputing the facts. In any event, a careful reader of the US study we cited,2 for example, will find therein explicit treatment of racism, medical abuse, and public trust (page 2 of the study). This finding has direct bearing on vaccine hesitancy and the history of colonial medicine and medical abuse in Africa, as shown by several studies (see Lowes and colleagues for a sample). Full-Text PDF Open Access